2018/12/01 GHD, Inc. Certificate of Liability InsurancePage 1 of 1
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
114� 06/13/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME -
Willis of Massachusetts, Inc. PHONE 1-877-945-7378 PAX 1-888-467-2378
c/o 26 Century Blvd AIC. Na
P.O. Box 305191 E-MAIL
p ESS; COZtifiCates@willis.com
Nashville, TN 372305191 USA INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Allied World Assurance Company US Inc 19489
INSURED INSURERS; Zurich American Insurance Company 16535
GILD Inc. ---
winsler s Kelly INSURERC:
3750 Convoy Street, Suite 220 INSURER D :
San Diego, CA 92111 USA - -'—
INSURER E
COVERAGES C:F_RTIFICATE N111VIEtFR• W11608116 QeVlelnm Alllluare.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
y
ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
POLICY NUMBER MMrDD;YYYY MM�DDrYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
_�$
nAMAGE Ti 116mTEO
f� CLAIMS -MADE X OCCUR PREMISES[E4 gpwlr elj $ 11000,000
A
MED EXP (Any one person) $ 25,000
Y Y 0310-4497 12/01/2018 12/01/2019 �1,000,000
�FEFSONAL & ADV INJURY $GEN'L
AGGREGATE LIMIT APPLIES PER: NERAL AGGREGATE $ 2, 000, 000
POLICY X PRO LOC I 2,000,OOD
-__ - PRODUCTS - COMP/OP AGG $
OTHER' $
AUTOMOBILE LIABILITY CICIMSIN INGLE LIMIT $ 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
B
OWNED SCHEDULED Y Y BAP 3757423-04 07/01/2019 07/01/2020, BODILY INJURY (Per accident) $
AUTOS ONLY ; AUTOS
HIRED I PROPERIY�E
X
pNIOIN-OWNNEDD
CollOUedN 00 x CoinpO§.%i L25o $ .. (Per agpdWA)-.
- -
X X Aired Physical Damag $ 100000
A
UMBRELLA LIAB X OCCUR
EACHOCCUR_RENCE $ 5,000,000
X EXCESS LIAB CLAIMS -MADE
Y
Y
_
0310-4498 12/01/2018 12/01/2019 AGGREGATE $ 5,000,000
DED RETENTION$
g
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY YIN —__ STATUTE-_.__ _..ER_
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT 5
OFFICER/MEMBER EXCLUDED? N / A
❑
(Mandatary In NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
General Liability/Automobile Liability Additional Insured: City of Menifee. Coverage is Primary and Non -Contributory.
Severability of Interest applies. Blanket Waiver of Subrogation applies to General Liability and Business Auto
policies as required by written contract. Blanket Additional Insured applies to General Liability and Auto Liability
as required by written contract. Umbrella/Excess Liability Follows Form over General Liability and Auto Liability.
aA ais■ I io[will a i s w] a a]a: .7.1-1TOT J;t1.i_4r.1.
City of Menifee
City Clerk
E DESCRIBED I D BEFORE
ES BE CBECDELIVERED
UEXPIRATION LD ANY OF HDATE VTHEREOF,
THE NOTICE WILL IN
ACCORDANCE WITH THE POLICY PROVISIONS.
? U is
AUTHORIZED REPRESENTATIVE
� `
City of Menifee
Haun Road
Sun C
Sun City, CA 92586
- W 1VtW-ZU16 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SR In: 18099657 BATCH: 1239760
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POLICY NUMBER: 0310-4497
COMMERCIAL GENERAL LIABILITY
CG 20 3710 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Where required by written contract
Location And Description of Completed Operations:
Where required by written contract
Additional Premium:
N/A
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the
schedule of this endorsement performed for that insured and included in the "products -completed operations haz-
ard".
CG 20 3710 01 O ISO Properties, Inc., 2000 Page 1 of 1 O
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Coverage Extension Endorsement
�91
ZURICH
Policy No. Eff. Date of Pol. Exp. Date of Pol. I Eff. Date of End. I Producer No. Add'I. Prem Return Prem.
BAP 3757423-04 7/1 /2019 7/1 /2020 7/1 /2019
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section II —Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts
performed within the scope of employment by you. Any "employee" of yours is also an "insured" while
operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your
permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or
borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement.
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract
or written agreement with you executed prior to any "accident", including those person(s) or organization(s)
directing your work pursuant to such written contract or written agreement with you, provided the "accident"
arises out of operations governed by such contract or agreement and only up to the limits required in the
written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you
executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained
by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond
the terms and conditions of the Coverage Form.
All other terms, conditions, provisions and exclusions of this policy remain the same.
U-CA-424-F CW (04/14)
Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
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